There a number of reasons why HMS is the strategic source for innovative cost containment solutions in healthcare. Cynthia Nustad is one of them. As CIO, Cynthia is responsible for the company’s technology strategy and leading the department to grow and strengthen the business and she takes her duties seriously. In 2013 she was awarded the Computerworld Premier 100 IT Leader award and also was a finalist for the MIT CIO Award – Transformational CIO – Architecting the Enterprise of the Future. In addition, she represents HMS as an active industry speaker.Nustad brings extensive experience in technology and healthcare to HMS. Her 18 years of information technology management experience spans technical start-ups to complex Fortune 100 companies, and includes executive experience in enterprise technology and business transformation. She has extensive healthcare technology experience as well, and has held executive positions with both technology vendors and healthcare payers. Her broad experience includes designing and managing commercial systems solutions specific to healthcare, integrating and managing applications and portfolios, leading enterprise architecture, developing systems and strategies to meet business needs, and growing talented, high-caliber teams—who have received numerous industry awards.Prior to HMS, Nustad served as the VP, Architecture & Technology for Cambia, a four-state Blue Cross Blue Shield plan, as Vice President Product Management for OAO Healthcare Solutions, Inc. She has also held technology leadership roles at e-MedSoft.com and WellPoint.Nustad holds a MBA from the University of Oregon, and an MPH and Bachelor of Arts from UCLA.

1. Tell us a little bit about yourself; our subscribers would like to know you and your business.

Cynthia Nustad: I have spent my entire career in healthcare technology, including time with large payers, software, and service vendors. I am passionate about simplifying our healthcare landscape and bettering the healthcare system. My company, HMS, is the nation’s leader in coordination of benefits and program integrity services for healthcare payers. Our clients include health and human services programs in more than 40 states; commercial payers, including group health plans, Medicare Advantage Plans, more than 150 Medicaid managed care plans, and employers; the Centers for Medicare and Medicaid Services; and Veterans Administration facilities. As a result of our services, our clients recovered more than $3 billion last year, and saved billions more through theprevention of erroneous payments.

2. You have been in the CIO role since 2011 and the healthcare industry has seen a lot during this time. How has this role changed since you started and what are the top challenges you see for payer CIOs in coming years?

Cynthia Nustad: As I become a bit reflective, it is honestly quite shocking to see how much the role has changed in the nearly four years I have been at HMS. As a CIO, you lead your teams to focus on executing projects that deliver business support. These have typically been infrastructure-based, business enablement-based or roadmap-fulfillment initiatives. The areas I see our teams emerging in are much more business-strategy related: specifically, recommending and presenting M&A opportunities that could help fill strategic business and technology needs, and finding solutions that would reach across companies or partnerships to improve efficiencies in healthcare. Technology teams can help address greater cost pressures in our industry and simplify the work. We will see true transformation when companies and even competitors can work together to improve the whole system versus their own specific company gains.

3. As healthcare moves towards a retail model, what are the top strategies you see in the market place to drive Consumer centricity?

Cynthia Nustad: Consumerism is certainly alive and well in healthcare. here has been tremendous investment in start-up’s, spin-offs and the like applying Web 3.0 technologies to healthcare. The past 5-10 years has seen amazing invention, and this will only multiply as the pace of change quickens in the industry. One strategy to deploy is to find ways to coalesce the application-level simple capabilities into one common ecosystem. I liken this to shared applications on a common base, much like the application store on your iPhone/iPad. I relish the day when we move beyond dozens of logins for our medical histories, our eligibility and payment responsibilities, doctor ratings, appointments, personal health data trackers, logs and the like, into seamless user experiences.

4. What do you see as the role of cloud computing in the industry? What is your advice to other executives on leveraging the cloud?

Cynthia Nustad: The cloud is an important tool in our arsenal to manage technology and business. Cloud providers can help with scale. They can stay on top of and supply the features and functionality needed, and they can assist in off-loading some of the IT work so that the in-house IT teams can focus their time and energy on differentiating the products and services of their company. My advice would be to think of framing questions as a “cloud first” mentality, and add external cloud vendors to the decision mix in any business or technology change. Certainly companies will want to hold their proprietary intellectual property close to the vest, but having partners to accelerate business strategy makes complete and good business sense.

5. IT is playing a key role in driving change in the Industry. How can today’s payer organizations bring IT and business alignment in a dynamic environment driven by healthcare reform?

Cynthia Nustad: Payers can align the team on corporate goals–especially ones that have shared visions. A great area to start with is data. Data is a strategic asset where both the business and technology need alignment to farm the best value internally and even externally. Today it really isn’t a them-against-us game anymore… Technology is inherent in all that we do; it is foundational to a business’s success. Today’s business leaders have to possess technology acumen, just as technology leaders must have business acumen.

6. Sometime back you had indicated that one of your top priorities would be to maintain a scalable human, technology and process infrastructure. Nowadays finding the right skill/knowledge mix is one major challenge for Healthcare IT. How have you managed to keep your team scalable despite changing technology and business models?

Cynthia Nustad: Hiring, retaining, and growing talent is one of my top priorities, and frankly in today’s market these are much harder tasks than in previous decades. IT professionals are in high demand, but they are absolutely critical—especially to HMS since technology and data are fundamental to our company strategy. We employ many techniques to help us win the war for talent. We like to recruit and hire staff that have a passion for doing something special in healthcare. We communicate often, reward and recognize, and employ college recruitment programs. We ensure that our existing staff has many opportunities to learn new technologies. And we pride ourselves on not being just a back office IT department.

7. Social media/mobility has brought significant revolution within IT in many industries. How do you see the adoption of Social media/mobility as playing a critical role in the payer industry? How is HMS planning to use this area to bring differentiation to its clients?

Cynthia Nustad: Because all industries have customers, and all customers talk, it’s clear that social media is critical for all industries. Some payers have been slow to recognize the opportunities presented and the challenges posed by Facebook, Twitter, LinkedIn and other social platforms. Late adopters can find themselves having no voice in conversations and that can have a negative impact. Through our analytics, HMS helps our clients marshal their data to help them make the best case on social media about how they bring value to the healthcare system.

8. With the implementation of the ACA, the HIE, the introduction of new provider models such as ACO and transition into customer centricity have all posed significant challenges to payers’ business model. In your view, how will Big Data play a critical role in helping payers create a balance among quality, cost, and revenue?

Cynthia Nustad: HMS stands at the forefront of reducing fraud, waste, and abuse in the healthcare system. We partner with private and government healthcare payers to ensure that claims are paid appropriately. Last year, we generated $3 billion in recoveries and billions more in cost avoidance savings for our clients. As a result of a new focus on quality outcomes, an emphasis on consumer-driven care, and the advent of the Affordable Care Act, our clients are looking beyond their own data to provide the best healthcare possible while managing their costs. With our 5.5 petabytes of claim and eligibility data covering one out of every three Americans, HMS holds a unique position in the industry. Today, we have the historic opportunity to aggregate this data – with client permission – to leverage best practices, identify regional and national cost trends–and improve the healthcare system for all.

9. What top technology trends should we be on the lookout for in the Payer IT industry for 2014-15?

Cynthia Nustad: I see several areas gaining momentum: 1) leveraging big data to advance our industry; 2) simplifying payment responsibilities; 3) creating technology strategies to ensure our payment streams have more of a value component vs. the traditional contracted rate or fee-for-service; 4) building ecosystems to knit together disparate technology assets to delight healthcare consumers; 5) developing user experiences to engage employees and customers; and 6) de-coupling large heritage payer computer systems into more nimble assets that can flex and change along with our industry.

10. As you network and talk to CIOs from outside healthcare industries, what similarities do you find?

Cynthia Nustad: It seems like all my conversations with fellow CIOs revolve around three central tenets: 1) the pace of change and our need to be out in front of it; 2) leveraging our data assets strategically; and 3) finding the talent to achieve our strategic goals.

11. In your view, what are the top challenges health plan executives must prepare for in the coming 2-3 years?

Cynthia Nustad: I see continued challenges with cost pressures. Health plan executives can leverage internal- and external-sourced companies to help solve those issues.I would like to see more in-industry collaboration to jointly help solve problems and save costs. In markets that are mature, companies wouldn’t want to create duplicate fraud, waste, and abuse services. It’s in everyone’s best interest to vet doing the work in-house for finding solution providers to can advance your strategies at lower risk.I also see great opportunities, as necessity is the mother of invention. As the industry morphs, there will be newfound partnerships, business models, and competitive differentiators. Many of the relationships may test the comfort levels of the past, but new ways of partnering are needed for transformation.I would also like to see boards of directors moving away from viewing IT as a cost center and seeing it as a more strategic department that can provide differentiation through technology discussions.

12. What kind of services does HMS offer to the Payer Industry? Can you share a brief unique success story?

Cynthia Nustad: HMS provides solutions to government and commercial payers, as well as employers. Effective algorithms differentiate our work. For instance, not long ago our fraud, waste, and abuse group flagged a home health provider who had been overpaid by the state Medicaid agency for three years running. The provider had incorrectly documented services, miscalculated or overestimated time on timesheets, missed prior authorizations, and excluded proper modifiers — a claim error rate of 8%. The extrapolated value of the overpayments was $2.1 million. And that’s just one home health provider.

13. To close, time management is a critical aspect of all successful CIOs. What top three things do you make sure are on your everyday agenda? Any advice on the best ways for executives to manage time and be more productive?

Cynthia Nustad:Yes, time management is always a challenge. I tend to employ several techniques that have helped over the years. I hire the best and brightest to be on the team, lessening the amount of oversight needed to ensure high performance. I don’t agree to every meeting request that comes across the system; it’s important to ferret those needed to advance, versus less productive meetings. I use all kinds of vehicles to communicate with my teams to ensure I reach them in ways that work best for each of them. I also focus on my most important tasks when I am the most fresh and alert; high-productivity times are escalators to getting a lot accomplished.